By Karyne Vinales, MD, Endocrinologist, Phoenix VA Healthcare System
Last year was replete with racial unrest in cities throughout the country. Organizations large and small released statements denouncing racism or recognizing racism as a public health threat. Many organizations held virtual discussions about ways to reduce racist policies and practices and increase diversity in their communities. Physicians were among those voices calling for action.
Before acting, we need to consider diversity of the physician workforce. Here, I examine why it matters, how diverse the physician workforce is today, what it should be, and what to do about creating the future we want.
Why does a diverse physician workforce matter?
It matters because greater diversity of physicians can lead to more and better care delivered to our local population, specially the underserved and minority populations. According to the Institute of Medicine, researchers found sufficient evidence “to support continued efforts to increase the number of physicians from underrepresented minority groups.”[i] Here are some examples.
Researchers at Penn Medicine analyzed 117,589 Press Ganey Outpatient Medical Practice Surveys, which measure the patient experience, and found that higher scores “were associated with racial/ethnic concordance between patients and their physicians.”[ii] Junko Takeshita, MD, PhD, MSCE, the study’s corresponding author, noted “patients who see physicians of their own race or ethnicity are more likely to rate their physicians higher than patients who see physicians of a different race or ethnicity.”
In a recent study of physician-patient racial concordance, researchers found Black babies had a 50% higher chance to survive the neonatal period if they were cared by a Black physician.[iii]
It is also important to note that diversity exposure during medical school increases students’ attitudes about importance of culture and awareness regarding societal issues, making students who attended more diverse medical schools better equipped to care for patients in a diverse society.[iv],[v] In the study by Dr. Saha, almost 50% of the underrepresented minority medical students were planning to serve the underserved population, almost three-fold higher rate than non-underrepresented students. If we invest in training more minority students, perhaps we can assist states like California, where physician supply was inversely proportional to the number of Blacks and Hispanics in both urban and rural areas in a study. Although it is not difficult to guess that other states suffer from same fate.[vi]
Diversity among physicians today
There are several ways to examine workforce diversity, chief among them race/ethnicity and gender.
According to the American Medical Association, there are approximately 64% of physicians in the United States who identify as male and 36% who identify as female. This gap is decreasing, as half of graduating medical students are female, at least over the last five years, according to data from the Association of American Medical Colleges (AAMC).[vii] However, decreasing the gap needs to be accompanied by pay equity. The average female physician earns about 75 cents to a male physician’s dollar.[viii]
Regarding race, data from the AAMC shows that 56.2% (516,304) of active physicians throughout the United States identified as White. There were 17.1% who identified as Asian, 5.8% as Hispanic, 5.0% as Black or African American, 1.0% as Multiple Race – Non-Hispanic, 0.8% as Other, and 0.3% as American Indian or Alaska Native. A sizable 13.7% of race/ethnicity is identified as Unknown.[ix] For comparison, 13.4% of the U.S. population identifies as Black, according to U.S. Census estimates in 2019.[x]
Goals for future diversity
A service industry workforce should represent the population it is serving. As a work environment, a diverse physician workforce can increase employee morale, provide better care for diverse populations, increase employee retention, provide better recruitment, possibly enhance individual motivation and thus problem solving, and all those reasons combined, provide better results in patients care. viii
However, we cannot work effectively to increase diversity if we do not have a real grasp of the problem. By having a better idea of the gaps we are facing, we will be able to tailor solutions and bring key collaborators together to drive changes.
While we have decent data regarding physician diversity at the national level, there are not good numbers for Arizona. At least, not yet. The Arizona Medical Board is now requesting demographic data of physicians who submit requests for either a new or renewal license to practice. Although the questions are not required, we will have, over time, more data about physician diversity.
What to do next?
Consider what is within your control. When you renew your license, please answer voluntary questions about demographic data. If you employ physicians in your hospital or practice, then create a plan for recruiting and retaining a more diverse physician workforce. Ensure that well-qualified physicians of all demographics are considered equally for leadership roles. Review the pay provided to physicians in your hospital or practice and determine whether there are disparities based on race or gender.
Encourage youth in Black, Latinx, Asian, or native American communities to study in the science, technology, engineering, or math (STEM) fields, which are common disciplines for the pipeline to medical schools.
[i] Kingston R, Tisnado D, Carlisle D. Increasing Racial and Ethnic Diversity Among Physicians: An Intervention to Address Health Disparities. Institute of Medicine, Washington, DC: National Academies Press, 2001.
[ii] Takeshita J, Wang S, Loren AW, et al. Association of Racial/Ethnic and Gender Concordance Between Patients and Physicians With Patient Experience Ratings. JAMA Netw Open. 2020;3(11):e2024583. doi:10.1001/jamanetworkopen.2020.24583
[iii] Greenwood B, Hardeman R, Huang L, Sojourner A. Physician–patient racial concordance and disparities in birthing mortality for newborns. Proceedings of the National Academy of Sciences Sep 2020, 117 (35) 21194-21200; DOI: 10.1073/pnas.1913405117
[iv] Guiton G, Chang MJ, Wilkerson L. Student body diversity: relationship to medical students' experiences and attitudes. Acad Med. 2007 Oct;82(10 Suppl):S85-8. doi: 10.1097/ACM.0b013e31813ffe1e. PMID: 17895700.
[v] Saha S, Guiton G, Wimmers PF, Wilkerson L. Student Body Racial and Ethnic Composition and Diversity-Related Outcomes in US Medical Schools. JAMA. 2008;300(10):1135–1145. doi:10.1001/jama.300.10.1135
[vi] Komaromy, M, Grumbach, K, Drake, M, Vranizan, K, Lurie, N, Keane, D, and Bindman, AB (1996). The role of black and Hispanic physicians in providing health care for underserved populations. New England Journal of Medicine; 334, pp.1305–1310. [PubMed]
[vii] Association of American Medical Colleges. Medical School Graduation Questionnaire, 2020 All Schools Summary Report. Washington, DC: July 2020.
[viii] Narayana S, Roy B, Merriam S, et al. Minding the Gap: Organizational Strategies to Promote Gender Equity in Academic Medicine During the COVID-19 Pandemic. J Gen Intern Med. 2020 Dec; 35(12): 3681-3684; 10.1007/s11606-020-06269-0
[ix] Association of American Medical Colleges. Diversity in Medicine: Facts and Figures 2019. Figure 18. Percentage of all active physicians by race/ethnicity, 2018. Washington, DC: Accessed on April 13, 2021 online at https://www.aamc.org/data-reports/workforce/interactive-data/figure-18-percentage-all-active-physicians-race/ethnicity-2018.
[x] QuickFacts, United States, July 1, 2019. United States Census Bureau. Washington, DC: Accessed on April 13, 2021 online at https://www.census.gov/quickfacts/fact/table/US/PST045219